What is known?
Mechanical thrombectomy is a highly effective but time dependent treatment for acute ischaemic stroke caused by large vessel occlusion. In the UK, the national clinical guidelines for stroke and National Institute for Health and Care Excellence guidance endorse thrombectomy as an acute stroke treatment. The initial commissioning of thrombectomy in the UK began with the 24 tertiary neuroscience centres; however, many of these operate only within working hours.
What is the question?
There are no UK ‘real-world’ data to verify the efficacy of the hub-and-spoke model in thrombectomy. This study was to investigate the safety and efficacy of a 24/7 UK thrombectomy service using a hub-and-spoke model.
What was found?
Our data showed that the hub-and-spoke thrombectomy service in routine UK 24/7 clinical practice is as effective and safe as the randomised controlled clinical trials. However, 9.3% of patients did not proceed to thrombectomy due to established infarction on arrival. Fifty-three per cent of thrombectomy cases were performed outside of standard working hours when transfer delays increased.
What is the implication for practice now?
This study is the first to show that a hub-and-spoke thrombectomy service in routine UK NHS clinical practice is safe and effective. A 24/7 thrombectomy service is needed to maximise the benefit to all suitable patients. We need measures such as improving workflow and optimising workforces across the thrombectomy pathway to minimise the delays and continue to improve the service.